The effects of cardiac structure, valvular regurgitation, and left ventricular diastolic dysfunction on the diagnostic accuracy of Murray law–based quantitative flow ratio

Yang, Jing; Huang, Yuming; Li, Xiaoshan; Jia, Quanli; Deng, Huiliang; Xie, Nianjin; Huang, Meiping; Fei, Hongwen

doi:10.3389/fcvm.2023.1134623

Cited by 3 publications

References 26 publications

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Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics

Asano,

Tanigaki,

Ikeda

et al. 2024

Cardiovasc Interv and Ther

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Invasive functional coronary angiography (FCA), an angiography-derived physiological index of the functional significance of coronary obstruction, is a novel physiological assessment tool for coronary obstruction that does not require the utilization of a pressure wire. This technology enables operators to rapidly evaluate the functional relevance of coronary stenoses during and even after angiography while reducing the burden of cost and complication risks related to the pressure wire. FCA can be used for treatment decision-making for revascularization, strategy planning for percutaneous coronary intervention, and procedure optimization. Currently, various software-computing FCAs are available worldwide, with unique features in their computation algorithms and functions. With the emerging application of this novel technology in various clinical scenarios, the Japanese Association of Cardiovascular Intervention and Therapeutics task force was created to outline expert consensus on the clinical use of FCA. This consensus document advocates optimal clinical applications of FCA according to currently available evidence while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software. Graphical abstract Overview and proposed clinical applications of functional coronary angiography (FCA). The FCA was developed according to computed fluid dynamics (CFD), considering the pressure drop across the coronary stenosis. CFD analysis was performed with a three-dimensional coronary model derived from angiography, allowing the calculation of the physiological index without the use of a pressure wire. Another direction of development in FCA is using artificial intelligence throughout the entire process, enabling “hands-free” FFR simulation. The advantage of the FCA is that it eliminates the use of a pressure wire, resulting in reduced invasiveness, shorter procedure times, and reduced medical costs. However, FCA requires high-quality angiography for a clear visualization of the lesion. In addition, the current version of FCA requires several manual corrections; thus, its reproducibility is limited. Further data on clinical outcomes after the use of FCA, such as percutaneous coronary intervention (PCI) with FCA guidance, are warranted. The consensus group of the Japanese Association of Cardiovascular Intervention and Therapeutics proposed the application of FCA in various clinical scenarios considering the advantages of this technology. QFR, quantitative flow ratio; iFR, instantaneous wave-free ratio; CCS, chronic coronary syndrome; ACS, acute coronary syndrome; MVD, multivessel disease; AMI, acute myocardial infarction.

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Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics

Asano,

Tanigaki,

Ikeda

et al. 2024

Cardiovasc Interv and Ther

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Validation of angiography-derived Murray law-based quantitative flow reserve (μQFR) against pressure-derived instantaneous wave-free ratio for assessing coronary lesions, a single-center study in Egypt

Samaan,

Mostafa,

Wahba

et al. 2024

Egypt Heart J

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Background Instantaneous wave-free ratio (iwFR) is a well-validated method for functional evaluation of intermediate coronary lesions. A recently developed Murray law-based QFR (µQFR) allows wire-free FFR estimation using a high-quality single angiographic projection. We aim to determine the diagnostic accuracy of µQFR as compared to wire-based iwFR for physiological assessment of coronary lesions in a sample of Egyptian patients. Results Over a one-year period, patients who previously underwent iwFR assessment of an intermediate coronary stenosis (40–90%) were retrospectively included. μQFR analysis was then performed offline using a dedicated artificial intelligence (AI)-aided computation software. All the measurements were performed blinded to iwFR results, and the agreement between iwFR and μQFR values was tested. Forty-nine patients (mean age 57.9 ± 9 years, 72.9% males) were included. Mean value of iwFR and μQFR was 0.90 ± 0.075 and 0.79 ± 0.129, respectively. There was a significant moderate positive linear correlation between μQFR and iwFR (r = 0.47, p = 0.001; 95% CI 0.22–0.68) with moderate-to-substantial agreement between the two methods (Kappa 0.6). In assessing the diagnostic accuracy of μQFR, the receiver operating characteristic (ROC) curve yielded an area under the curve (AUC) of 0.84 (95% CI 0.717–0.962) for predicting functionally significant lesions defined as iwFR < 0.89. The sensitivity and specificity of μQFR < 0.8 for detecting physiological significance of coronary lesions were 89% and 74% with positive and negative predictive values of 70 and 91%, respectively. Conclusion µQFR has good diagnostic accuracy for predicting functionally significant coronary lesions with moderate correlation and agreement with the gold standard iwFR. Angiography-derived µQFR could be a promising tool for improving the utilization of physiology-guided revascularization.

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Morphometric assessment for functional evaluation of coronary stenosis with intravascular ultrasound and ultrasonic flow ratio in vessel with single stenosis

Huang,

Zhang

et al. 2023

Preprint

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Background: The ultrasonic flow ratio(UFR) derived from morpho-functional computational method by IVUS image. UFR can identify the functional severity of coronary stenosis, but it is unclear whether UFR would improve diagnostic accuracy of IVUS in determining coronary stenosis hemodynamics in single-stenosis lesion. Aim: The study investigatedthe diagnostic performance of intravascular ultrasound-derived parameters (IVUS) in identifying functionally significant coronary stenosis in a vessel with single stenosis. Methods: 68 patients with 70vessels were enrolled in this single stenosis study, all vessels were performed with IVUSand Murray law based quantitative flow ratio (μQFR), and IVUSimages were used to perform UFR. Results: UFR showed a good correlation with μQFR(r =0.87; p <0.001). With μQFRas the reference, the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of UFR was98.57%, 95%, 100%, 100.00% and 98%, respectively. With UFR/μQFRconcordance, lesion length, minimal lumen diameter (MLD), diameter stenosis (DS), and area stenosis (AS) in quantitative coronary angiography (QCA), minimal lumen area (MLA), plaque burden, and plaque volume in IVUS showed excellent diagnostic efficiency in determining the functional significance of coronary stenosis in a vessel with single stenosis. Multiple logistic regression models, including the lesion length and DS in QCA, and MLA in IVUS provided superior predictive efficacy for physiologically significant ischemia. Conclusions: UFR has a good correlation with μQFR. IVUS derived parameters have excellent diagnostic efficiency in identifying the hemodynamic significance of coronary stenosis in a vessel with single stenosis.

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The effects of cardiac structure, valvular regurgitation, and left ventricular diastolic dysfunction on the diagnostic accuracy of Murray law–based quantitative flow ratio

Cited by 3 publications

References 26 publications

Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics

Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics

Validation of angiography-derived Murray law-based quantitative flow reserve (μQFR) against pressure-derived instantaneous wave-free ratio for assessing coronary lesions, a single-center study in Egypt

Morphometric assessment for functional evaluation of coronary stenosis with intravascular ultrasound and ultrasonic flow ratio in vessel with single stenosis

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